Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 02004296A | IN |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DOS 918 | HI |
NPI | 1336394881 |
---|---|
Provider Name | Lisa R. Chun |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46222-1960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2008 |
Last Update Date | 14/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201207980 | (05) | IN |
235572 | HMSA LEGACY (01) | |
55122 | (02) | |
P01424287 | RAIL ROAD PTAN (01) | IN |